ABSTRACT
Objective To explore the effect of posterior column stability and decompression on the treatment of lumbar burst fracture with nerve injury and its effect on vertebral body and neurological function.Methods Fifty-two cases patients of lumbar burst fracture with nerve injury from February 2005 to July 2014 in Affiliated Hospital of Youjiang Medical College For Nationalities were selected as the research objects and divided into retention group(28 cases) and non-retention group(24 cases) according to the choice of operation method.The surgical clinical efficacy,the changes of the vertebral body and nerve function were compared between two groups.Results At 3 months,6 months and 12 months after operation,the fusion rate,sagittal diameter and the height of the injured vertebral body,pre-vertebral body,and intervertebral space were all significantly increased,while the Cobb angle,the pressure area and the sagittal displacement rate were markedly decreased(F of inner grouP=10.492,8.858,7.432,16.311,19.491,10.329,21.587;P0.05).After operation,the ASIA grade gradually improved,neurological function of the retention group recovered at 6 months after surgery,while non-retention group presented this effect at 12 months after surgery,moreover,at 12 months after operation,the proportion of E grade in retention group was 64.29%,higher than that of non-retention group(45.83%,F=12.758,P<0.001).The levels of neuron-specific enolase(NSE),S100B protein and myelin basic protein(MBP) in retention group were significantly lower than those of the non-retention group at 3 months after surgery(P<0.05).The improvement of S100B and MBP in the reservation group at 6 months after surgery were better than those of non-retention group,while at 12 months after surgery,only the improvement of MBP in retention group showed the better effects than non-retention group.Conclusion Posterior column stability and decompression show a high clinical efficacy on the treatment of lumbar burst fracture with nerve injury and it can significantly improve the vertebral body and neurological function.
ABSTRACT
STUDY DESIGN: This is a retrospective clinical study. OBJECTIVES: To know how the associated foot or ankle fracture influences the fracture pattern in the thoracolumbar burst fractures caused by falls from height. SUMMARY OF LITERATURE REVIEW: There were few studies on how the foot or ankle fracture influences the thoracolumbar fracture caused by falls from height. MATERIALS AND METHODS: We reviewed 46 subjects, who underwent surgery due to burst fracture of the thoracic or lumbar region, caused by fall accidents, from May 2004 to October 2008. Among them, we defined 19 cases that had associated foot or ankle fractures as group A, and the other 27 cases as group B. We analyzed the differences of radiological and clinical findings, and functional outcomes between the two groups. RESULTS: The falling heights were higher in group A than in group B (P<0.01). Thoracolumbar junction (T11-L2) was the most common location involved in both groups, but group A had more fractures on the lower lumbar region (L3-5), relatively (p=0.03). Kyphotic deformity was more severe in group B (p=0.01) but there were no significant differences in the wedge angle, amount of canal compromise, compression rate of anterior column between both groups (p=0.08, 0.46, 0.76). More segments were fused in group B (P=0.04). Neurologic deficit was more common in group B (p=0.03), but there were many complications related with foot or ankle fractures in group A (38%).There was no significant difference in the final clinical outcome between both groups (Pain scale p= 0.48, Work scale p=1.00). CONCLUSIONS: In patients who had burst fractures in the thoracic or lumbar region associated with foot or ankle fractures, there was a tendency to increase the incidence of lower lumbar fracture, relatively. The neurologic deficits were less common in this group of patients, but there was no difference in the functional outcome.
Subject(s)
Animals , Humans , Ankle , Congenital Abnormalities , Foot , Incidence , Lumbosacral Region , Neurologic Manifestations , Retrospective StudiesABSTRACT
Recently anterior spinal device in the treatment of the unstable thoraco-lumbar spine has been used. We have experienced 11 patients of the unstable thoraco-lumbar spine, which were composed of 8 patients with burst fracture and 3 patients with tuberculous spondylitis. The 11 patients with neurological deficit were treated with an one stage anterior operation consisting of anterior decompression through vertebrectomy, realignment with Kanedae device. No patient showed neurologic deterioration after surgery. The anterior spinal instrumentation with Kaneda device afford enough stability to enable early ambulation with good alignment and solid fusion.